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Star database reveals antipsychotic drug use in Ontario nursing homes

Families of seniors living in Ontario nursing homes can now search online to see how many of each home’s residents are being given powerful antipsychotic drugs.

The database, created by the Star using previously unreleased government data, is available at thestar.com/nursinghomes . It gives the public an unprecedented snapshot of the antipsychotic use in more than 600 long-term care homes across the province. (If you are on a tablet, click here to access the database to see facilities on a map .)

Similar data is available in the United States, where a commitment to transparency and the public’s right to know this crucial information has led to a government-run database that allows people to search the antipsychotic rate at any home in their neighbourhood and beyond.

The U.S. website, called “ Nursing Home Compare ,” is a federal initiative. The data went public in 2012 to help raise awareness of unnecessary antipsychotic drug use, which the U.S. government called “a significant challenge in dementia care.”

The site’s “core mission,” according to Ed Mortimore of the U.S. Centers for Medicare and Medicaid Services (CMS), is to give consumers information that will help them pick a nursing home for aging relatives.

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It also allows consumers to compare a nursing home’s drug use rate to that in other homes in the state and across the country.

Alice Bonner, a former CMS employee who worked on the release of the U.S. data, said making the rates public can affect how nursing homes treat their residents.

“No nursing home wants to be the worst on the bar graph,” Bonner said. “The data may also raise awareness because nursing homes that are less sophisticated and don’t have a lot of data management may not know that they are an outlier. It raises awareness that this is an issue that at least they should be looking at.”

In Ontario — where the provincial government similarly tracks the number of residents on these drugs at each home, and where 35,000 nursing home residents are on the drugs — the public is in the dark. The Star obtained a six-month snapshot but much more data exists.

The provincial government should make the data public, said Liberal MPP Donna Cansfield.

“It’s important that people have all of the information they need to make a good, informed decision or be able to ask questions when someone is in one of the homes or is going to be placed in one,” Cansfield said.

“Sometimes it’s just bloody hard to navigate the system. We should be providing the tools for people to do that.”

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Cansfield shared provincial data on antipsychotics that was the basis of a Star investigation that revealed provincially regulated nursing homes are drugging helpless seniors despite warnings on the medication labels that they can kill elderly patients suffering from dementia.

Some long-term care homes, often struggling with staffing shortages, are routinely doling out these risky drugs to calm and “restrain” wandering, agitated and sometimes aggressive patients. At more than 40 homes across the province, the Star found, roughly half the residents are on the drugs.

The Star’s database shows the percentage of residents at individual Ontario nursing homes given antipsychotic medication regardless of their diagnosis.

While some residents in Ontario long-term care homes may suffer from schizophrenia, bipolar disorder or another condition that antipsychotics are approved to treat, most — 63 per cent — suffer from dementia.

Experts say the drugs have a place in nursing homes to treat patients who have severe aggression or agitation caused by dementia. But there is a chorus of concern the drugs are being prescribed too routinely.

The Star found antipsychotic use rates at 631 nursing homes in the first half of 2013 averaged 33 per cent.

Today the Star is releasing the data on nursing homes so the public can search and compare.

The public’s ability to search “helps families to know that this is an important issue,” Bonner said, adding that research shows residents living in nursing homes with high prescribing rates are more likely to be dispensed an antipsychotic than those in other homes.

“In the U.S., consumer engagement is a big focus in health care right now. Consumers want all the information.”

Ontario Health Minister Deb Matthews told the Star that the data it is publishing — which is government data — is “raw” and “misleading.”

“I think it’s about providing the appropriate context,” she said. “I worry that it will be misinterpreted.”

Liberal MPP Donna Cansfield says the provincial government should make all the drug data regarding nursing homes public. She says it is important "that people have all of the information they need to make a good, informed decision or be able to ask questions when someone is in one of the homes or is going to be placed in one."

The Ontario Long-Term Care Association said the data does not reflect the realities at some homes, which have a “higher percentage of people with psychiatric conditions” and “more residents with severely aggressive dementias” for which antipsychotics may be appropriate.

And Health Quality Ontario , an independent provincial agency that, among other things, measures the quality of care at Ontario’s nursing homes, has been reluctant to disclose antipsychotic prescription rates for a similar reason.

The agency currently posts four indicators for each home , including the percentage of residents placed in physical restraints, but its advisory panel decided against disclosing home-by-home antipsychotic rates.

“There is good evidence that reporting this kind of data does help improve the quality of care,” said Irfan Dhalla, Health Quality Ontario’s vice-president. “We do want to think through very carefully whether it is fair or meaningful to report a particular indicator at the level of an individual nursing home.”

Bonner, now an associate professor of nursing at Northeastern University in Boston, said she heard the same criticisms when she and her team worked to publish similarly “raw” data on the use of antipsychotics in U.S. nursing homes.

“Transparency is worth it,” she said. “Maybe nursing homes get their leadership or their board into the building and say, ‘Hey, looks like we got a problem. What can we do about it?’ Maybe they start to get families and residents involved.”

The percentages in the public U.S. data are not meant to be “absolute report cards on the quality of a nursing home,” said Mortimore of the American-based CMS. “They’re supposed to be a guide. Some residents will be appropriately receiving antipsychotics. (But) the purpose (of the data) is to give a sense of the overall rate of the use of the drugs in the nursing homes.

“If you’re seeing a rate that’s higher than you’re comfortable with, that’s a conversation worth having with the nursing home. To ask questions, such as: What non-pharmacological strategies do you try?”

In partnership with nursing homes, caregivers and consumers, the U.S. federal government is trying to reduce inappropriate use of antipsychotics with, among other things, increased transparency to improve care for the country’s 1.5 million nursing home residents.

A recent U.S. government report said the national prevalence of antipsychotic use in long-stay nursing home residents went down 15 per cent over an 18-month period.

Meanwhile, in Ontario, health minister Matthews told the Star she is committed to informing the public but that “it’s important to respect the diversity of the homes in the province.”

“People should have access to as much information as possible to make informed decisions,” she said. “This is an issue that demands a thoughtful response.”

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